Overview

Aortic stenosis is when 1 of the 4 valves in your heart called the aortic valve is narrowed. Valves allow blood to flow in 1 direction through the heart.

If the aortic valve is narrowed, the heart cannot easily pump blood around your body. You might:

• be short of breath
• have chest pain
• feel dizzy when you exercise, which can cause fainting

The extra force needed to pump blood through the narrowed valve puts strain on the heart. This can lead to fluid on the lungs, swollen ankles and eventually heart muscle weakness.

If untreated, aortic stenosis usually gets worse with time.

You might be treated with a transcatheter aortic valve implantation (TAVI). A TAVI is a procedure where we put a new valve inside the narrowed aortic valve in your heart. You usually have a local anaesthetic. This means that you are awake, but do not feel any pain.

The treatment can improve how well your heart works. It can help with your symptoms and give you a better quality of life. A TAVI might also increase your life expectancy.

TAVI assessment

If you have aortic stenosis, we do tests to check if a TAVI is the best treatment for you.

Not everyone can have a TAVI. We need to check that your heart and blood vessels are suitable. We call this stage the TAVI assessment. 

If the assessment shows that the procedure is suitable , you decide whether you want to have this treatment. Aortic stenosis is a serious condition. It is likely that your symptoms will get worse if we do not treat them.

If you decide to have this treatment, a member of your heart team will contact you. They give you the details of your hospital appointment for the TAVI procedure. 

Read more about having the TAVI assessment.

TAVI procedure

You usually have a local anaesthetic for a TAVI. This means that you are awake, but do not feel any pain.

The procedure takes 1 to 2 hours. We use a thin tube (catheter) to put (implant) a new valve in your heart. This is a man-made (artificial) valve. It is made from metal and tissue from a pig or cow.

You need to stay in hospital for 1 to 2 days after the procedure, but this might be longer.

Read more about having a TAVI.

Risks of having a TAVI

As with any medical procedure, there are some risks when having a TAVI. Your heart team fully explains the possible risks to you.

The risks might include:

• heart rhythm problems (arrhythmias). These problems happen to 1 or 2 in 10 people (in 10% to 20% of cases)
• bleeding, bruising or pain at the wound site
• damage to an artery, which happens to 5 in 100 people (in 5% of cases). If this happens, you might need surgery or a percutaneous (through the skin) repair
• a moderate to severe leaky valve. This happens to 5 in 100 people (in 5% of cases)
• a slow heart rate, which might need a permanent pacemaker (a small device in the chest to help control the heartbeat). This happens to between 5 and 10 in 100 people (in 5% to 10% of cases)
• stroke, which happens to about 3 in 100 people (in about 3% of cases)
• kidney injury, which happens to about 3 in 100 people (in about 3% of cases)
• an infection
• a heart attack, which happens to less than 1 in 100 people (in less than 1% of cases)
• allergy to the X-ray dye used during the procedure
• needing open heart surgery. This happens to less than 1 in 100 people (in less than 1% of cases)

Rarely, problems with the device might lead to death. This could be because of one or more of the above risks.

Please speak to the nurse or doctor caring for you if you have any questions or concerns.

Other treatment options

Aortic valve replacement

Another treatment option for aortic stenosis is aortic valve replacement. We remove and replace the heart valve during surgery.

This is open heart surgery, which is more invasive than a TAVI. It can be more risky, particularly if you have other illnesses that increase your risk when having a general anaesthetic. A general anaesthetic is a medicine that makes you sleep during surgery, so that you do not feel any pain.

If you are referred for a TAVI, the risk of open heart surgery might be too high. It might have already been agreed that this is not an option for you.

Balloon aortic valvuloplasty (BAV) 

This procedure stretches open your aortic valve, which can help your symptoms for 3 to 6 months. However, after this time, the valve narrows again and your symptoms return. This does not improve your life expectancy.

Medicines

We cannot treat aortic stenosis with medicine. While medicine can help with some symptoms, it does not fix the narrowed valve.

Giving your permission (consent)

We want to involve you in decisions about your care and treatment. If you decide to have the TAVI procedure, we ask you to sign a consent form. Staff explain all the risks, benefits and other options before they ask you to sign. The consent form says that you agree to have the treatment and understand what it involves.

If there is anything that you do not understand or you need more time to think, please tell your heart team. It is your decision to have the procedure. You can change your decision at any time, even after signing the consent form. We respect your wishes at all times.

Follow-up appointments

We arrange for you to come back for an appointment in the outpatient clinic. This is usually within 4 months of leaving hospital. Sometimes, we might ask you to have an echocardiogram (ECG) at this appointment. An ECG is a simple test to record your heart rhythm.

We might ask you to come for another follow-up appointment several months or a year later.

If another hospital originally referred you, we might send you back into the care of your heart specialist there. They are then responsible for continuing to monitor you.

Information and support

British Heart Foundation (BHF)

The British Heart Foundation funds research into all heart and circulatory conditions and the things that cause them. Its website has helpful information about tests for heart conditions, heart valve disease, caring for someone with a heart condition and cardiac (heart) rehabilitation.

British Heart Valve Society 

The British Heart Valve Society is a professional group connected to the British Cardiovascular Society. This group includes different types of professionals who are interested in heart valve disease. Patients are also represented in the group.

The British Heart Valve Society aims to improve the care of people with heart valve disease in the UK. It does this by organising educational and training programmes, sharing information and raising awareness of the condition.

Heart Valve Voice

Heart Valve Voice is a group of people who have real experiences of heart valve disease. They include experts (GPs, heart specialists and heart surgeons), organisations representing people with heart conditions and patients.

Heart Valve Voice aims to increase awareness of heart valve disease in the UK and improve diagnosis and treatment.